实时剪切波弹性成像定量评价肾间质纤维化的相关研究

The related research on quantification evaluation of renal interstitial fibrosis and renal elasticity measured by real-time shear wave elastography

目的探讨实时剪切波弹性成像（shearwaveelastography，SWE）技术定量评价肾间质纤维化病理基础及相关研究。方法对90例慢性肾脏病（chronickidneydisease，CKD）患者（CKD组）及同期40例健康志愿者（对照组）进行肾弹性成像，CKD组进行肾活检病理学检查，Masson染色及PAS染色，采用计算机辅助定量分析，计算CKD组的间质纤维化（interstitialfibrosis，IF）图像百分比，根据IF％值将CKD组分为轻度（〈25％）、中度（25％～50％）、重度（〉50％）3组，比较各组间肾皮质杨氏模量值的差别及与IF病理改变的关系。结果对照组、IF轻度组、IF中度组及1F重度组右肾下极肾皮质杨氏模量值比较，除轻度纤维化组与中度纤维化组差异无统计学意义（P〉0．05），其余各组比较差异有统计学意义（x2=55．521，P〈0．001）；应用SWE技术区分IF各组的ROC曲线下面积、诊断界值、敏感性、特异性：对照组与CKD组分别为0．871、6．90kPa、76．67％、90．00％；轻度与中度IF组分别为0．778、9．50kPa、58．33％、85．11％；中度与重度IF组分别为0．850、11．12kPa、80．00％、85．70％。Spearman相关分析表明肾皮质杨氏模量与IF程度存在正相关（r=0．371，P〈0．001）。结论SWE技术可以作为一种定量评估CKD。肾间质纤维化的无创检查方法，有助于区分轻度和重度肾间质纤维化，但对轻度和中度肾间质纤维化的区分仍困难。

Objective To investigate quantification evaluation of renal interstitial fibrosis and renal elasticity measured by real-time shear wave elastography（SWE） in CKD patients. Methods Forty healthy volunteers and 90 CKD patients were examined on lower pole of the kidney by SWE. All CKD patients underwent renal biopsy, Masson staining and PAS staining were used to calculate the percentage of interstitial fibrosis （IF） by computer aided quantitative analysis. The CKD group was divided into three groups based on IF percentage, the IF percentage 〈25 % as mild group, 25 % -50% as moderate group, 50% as severe group. Youngrs modulus and pathology results of each group were compared. Correlation of Young＇s modulus value of renal cortex with renal IF were analyzed. Results Youngrs modulus at the lower pole of right renal cortex was statistically significant different from other groups（X2 = 55. 521, P 〈0. 001 ）, excepting for mild and moderate IF groups （ P 〈0. 05）. ROC curves analyses indicated that the AUC, cut- off value, sensitivity and specificity for SWE differentiating renal IF in control group and CKD group were 0.871,6.90 kPa, 76.67%, 90.00%, those in mild and moderate groups were 0.778, 9.50 kPa, 58.33%, 85.110%, those in moderate and severe groups were 0. 850, l i. I kPa, 80.00%, 85.70%, respectively. The Young＇s modulus of renal cortex has positively correlated with renal IF （r = 0.371, P 〈 0.001）. Conclusions SWE technology is an effective method to assess the different degree of renal fibrosis, it can beused to distinguish mild from severe renal fibrosis, but it is difficult to distinguish the mild from moderate fibrosis.